Abstract 14758: A Qualitative Study of the Organizational Strategies of High- and Low-Performing PCI Hospitals: Insights From TOP PCI
Background: Among hospitals that perform percutaneous coronary intervention (PCI) there is a more than two-fold variation in 30-day risk-standardized readmission and mortality rates (RSRR and RSMR). We sought to understand the sources of this variation, with particular attention to hospitals’ organizational strategies, including their enabling structures, strategies, and internal hospital environments.
Methods: We conducted a qualitative study of high- and low-performing PCI hospitals. Hospitals were selected based on their performance on 30-day RSRR and RSMR calculated using NCDR® CathPCI Registry® data linked with administrative claims data. We purposefully selected high- and low-performing hospitals that ranked in the top and bottom 10% of RSRR and 25% of RSMR to ensure diversity in teaching status, PCI volume, ownership structure, and geographic location. Site visits and in-depth interviews with key hospital staff involved in the care of PCI patients were conducted at selected sites until we reached theoretical saturation, which occurred after site visits to 9 high- and 4-low performing hospitals (194 interviews). A multidisciplinary team analyzed the data using grounded theory and the constant comparative method, using Atlas.ti software to facilitate data organization and retrieval.
Results: Several attributes of organizational strategies were evident in the high-performing and less prominent in the low-performing hospitals: 1) Organizational support and leadership within and across disciplines and departments; 2) A cohesive hospital identity and clear goals related to the care of PCI patients; 3) The use of active problem solving to facilitate quality improvement efforts; 4) Investments in training and education; 5) Both staff and leadership were engaged in efforts to improve workflow and work processes; and 6) Staff and leadership exhibited individual ownership of PCI patients and PCI-related processes of care.
Conclusions: Top-performing hospitals were characterized by an environment that supported investment in diverse and innovative organizational strategies. This may influence both the quality of clinical care and resulting outcomes of PCI patients.
- Percutaneous coronary intervention
- Quality improvement
- Health services research
- Interventional cardiology
- © 2013 by American Heart Association, Inc.